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	<title> Commodities Options Investment Exchange : Request Withdrawal </title>
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					<li><a href="?in=funding&do=new&typ=-1&uid=DD1DACA362D54C6AEEFA212B5FEECF15"><b>Withdrawal</b></a></li>
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		<!--  start page-heading -->
		<div id="page-heading">
			<h1>Request Withdrawal</h1>
		</div>
		<!-- end page-heading -->

		<table border="0" width="100%" cellpadding="0" cellspacing="0" id="content-table">
			<tr>
				<th rowspan="3" class="sized"><img src="images/shared/side_shadowleft.jpg" width="20" height="300" alt="" /></th>
				<th class="topleft"></th>
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				<td style="vertical-align:top"><div id="funding">
					<form name="form_fund" action="?in=funding&amp;do=new&amp;uid=DD1DACA362D54C6AEEFA212B5FEECF15&amp;post=1" method="post" onsubmit="chkForm(1);return document.value;">
						<table width="100%" border="0" cellspacing="0" cellpadding="0" align="center">
							<tbody><tr><td width="50%" valign="top">




								<div class="box">
									<h2>Bank Details</h2>
									<div id="bankdetails">
										<table width="350" border="0" cellspacing="0" cellpadding="2">
											<tbody><tr>
												<td class="lbl" width="100">&nbsp;</td>
												<td align="left" width="1%"><input name="fund_bank_online" type="checkbox" id="fund_bank_online" class="chk" value="1"></td>
												<td align="left" class="lbl">Online Banking</td>
											</tr>
											<tr>
												<th valign="top">Beneficiary</th>
												<td colspan="2" align="left"><input name="fund_benef" type="text" id="fund_benef" class="inp-form" value=""></td>
											</tr>
											<tr>
												<th valign="top">Beneficiary Address
												</th><td colspan="2" align="left"><textarea name="fund_benef_addr" id="fund_benef_addr" rows="" cols="" class="form-textarea"></textarea></td>
											</tr>
											<tr>
												<th valign="top">Bank Name
												</th><td colspan="2" align="left"><input name="fund_bank_name" type="text" id="fund_bank_name" class="inp-form" value=""></td>
											</tr>
											<tr>
												<th valign="top">Bank Address
												</th><td colspan="2" align="left"><textarea name="fund_bank_addr" id="fund_bank_addr" rows="" cols="" class="form-textarea"></textarea></td>
											</tr>
											<tr>
												<th valign="top">Bank Account
												</th><td colspan="2" align="left"><input name="fund_bank_accout" type="text" id="fund_bank_accout" class="inp-form" value=""></td>
											</tr>
											<tr>
												<th valign="top"><select class="txt" name="fund_bank_code_lbl">
													<option value="SWIFT" selected="selected">Swift Code</option>
													<option value="IBAN">IBAN Code</option>
													<option value="ABA">ABA# Code</option>
													<option value="BSC">BSC Code</option>
												</select>
												</th><td colspan="2" align="left"><input name="fund_bank_code" type="text" id="fund_bank_code" class="inp-form" value=""></td>
											</tr>
											<tr>
												<th valign="top">More Details
												</th><td colspan="2" align="left"><textarea name="fund_bank_more" id="fund_bank_more" rows="" cols="" class="form-textarea"></textarea></td>
											</tr>
											<tr>
												<td>&nbsp;</td>
												<td><input name="save_bank" type="checkbox" class="chk" id="save_bank" value="1"></td>
												<td class="lbl">Save Bank Details </td>
											</tr>
											</tbody></table>
									</div>
								</div>



							</td>

								<td align="left" valign="top">
									<div class="box">
										<h2>Transfer</h2>
										<table width="100%" border="0" cellspacing="0" cellpadding="2">
											<tbody><tr>
												<td width="100" class="lbl">Withdrawal</td>
												<td align="left"><input name="fund_total" type="text" id="fund_total" class="inp-form" value="0.00" onkeypress="jInput(this)" onblur="setPrice(1)" style="text-align:right"> USD</td>
											</tr>
											<tr>
												<td class="lbl">Fees</td>
												<td align="left"><input name="fund_fees" type="text" id="fund_fees" class="inp-form" value="15.00" onkeypress="jInput(this)" onblur="setPrice(1)" style="text-align:right"> USD</td>
											</tr>
											<tr>
												<td class="lbl">Total Withdraw</td>
												<td align="left"><input name="fund_value" type="text" id="fund_value" class="inp-form" value="0.00" readonly="" style="text-align:right"> USD</td>
											</tr>
											</tbody></table>
									</div>

									<div class="box"><table width="100%" border="0" cellspacing="0" cellpadding="2">
										<tbody><tr>
											<td class="lbl" width="100">Value Date </td>
											<td align="left"><select name="dd" id="dd" class="txt">
												<option value="1">01</option>
												<option value="2">02</option>
												<option value="3">03</option>
												<option value="4">04</option>
												<option value="5">05</option>
												<option value="6">06</option>
												<option value="7">07</option>
												<option value="8">08</option>
												<option value="9">09</option>
												<option value="10">10</option>
												<option value="11">11</option>
												<option value="12">12</option>
												<option value="13">13</option>
												<option value="14">14</option>
												<option value="15">15</option>
												<option value="16">16</option>
												<option value="17">17</option>
												<option value="18">18</option>
												<option value="19">19</option>
												<option value="20">20</option>
												<option value="21">21</option>
												<option value="22">22</option>
												<option value="23">23</option>
												<option value="24">24</option>
												<option value="25">25</option>
												<option value="26">26</option>
												<option value="27">27</option>
												<option value="28" selected="selected">28</option>
												<option value="29">29</option>
												<option value="30">30</option>
												<option value="31">31</option>
											</select>
												<select name="mm" id="mm" class="txt">
													<option value="1">Jan</option>
													<option value="2">Feb</option>
													<option value="3">Mar</option>
													<option value="4">Apr</option>
													<option value="5">May</option>
													<option value="6" selected="selected">Jun</option>
													<option value="7">Jul</option>
													<option value="8">Aug</option>
													<option value="9">Sep</option>
													<option value="10">Oct</option>
													<option value="11">Nov</option>
													<option value="12">Dec</option>
												</select>
												<select name="yy" id="yy" class="txt">
													<option value="2010">2010</option>
													<option value="2011">2011</option>
													<option value="2012">2012</option>
													<option value="2013">2013</option>
													<option value="2014">2014</option>
													<option value="2015">2015</option>
													<option value="2016">2016</option>
													<option value="2017" selected="selected">2017</option>
													<option value="2018">2018</option>
													<option value="2019">2019</option>
												</select>

												<input name="fund_type" type="hidden" id="fund_type" value="-1">
												<input name="fund_id" type="hidden" id="fund_id" value="137285752"></td>
										</tr>
										</tbody></table>
									</div>
									<div class="box">
										<h4 style="text-align:left">
											Fund transfers requests may be verified via telephone for fraud prevention purposes. Please make sure your contact phone number is current.<br><br>Funds returned due to incorrect bank details will be charged a $40.00 administration fee.</h4>
									</div>
									<div class="boxw">
										<table width="100%" border="0" cellspacing="0" cellpadding="0">
											<tbody><tr>
												<td align="center" nowrap="nowrap">
													<input value="  Request Withdraw  " type="submit" class="btn"></td>
											</tr>
											</tbody></table>
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